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LONGS DRUGS OF LEXINGTON
CH048190 CENTRAL NORTH ALABAMA HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL NORTH ALABAMA HEALTH SERVICES, INC.
Subdivision Name
CENTRAL NORTH ALABAMA HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH048190
Entity Address
110 Walker Ave NE
Huntsville, AL 35801-4739
Grant Number
H80CS00105
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
LONGS DRUGS OF LEXINGTON
Pharmacy Address
D/B/A AVITA PHARMACY 1051
1216 W MAIN ST
STE D
LEXINGTON, SC 29072-2453
Pharmacy Comments
Contract Details
Approval Date
10/14/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carleton H. A. Pyfrom, CEO
(256) 534-8659
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
10/14/2018
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